Improving Care for Rural Veterans: Are High Dual Users Different?

Authors

  • Preethy Nayar MD, MPhil, PhD,

    Corresponding author
    1. College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
    • For further information, contact: Preethy Nayar, MD, MPhil, PhD, Department of Health Services Research & Administration, College of Public Health, 984350 Nebraska Medical Center, Omaha, NE 68198-4350; e-mail: pnayar@unmc.edu.

    Search for more papers by this author
  • Fang Yu PhD,

    1. College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
    Search for more papers by this author
  • Bettye Apenteng BSc

    1. College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
    Search for more papers by this author

  • Funding for this study was provided by the Department of Veterans Affairs, VA Nebraska – Western Iowa HCS, Omaha Division, Contract No. VA 263-BO-0102. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The views expressed are solely those of the authors and do not necessarily represent those of the Department of Veterans Affairs.

Abstract

Background

Rural veterans face considerable barriers to access to care and are likely to seek health care services outside the Veterans Health Administration (VHA), or dual care.

Objective

The objective of this study was to examine the characteristics of high users of dual care versus occasional and nonusers of dual care, and the determinants of satisfaction with care received by rural veterans.

Design

The design was a cross-sectional observational study.

Participants

Structured telephone interviews of a random sample of veterans residing in rural Nebraska were conducted in 2011.

Main Measures

Veterans’ frequency of use of dual care and satisfaction with care received were assessed using multinomial and ordinal regression models.

Key Results

Veterans who have an established relationship with a VHA provider or a personal doctor or nurse at the VHA and those who were more satisfied with VHA quality of care were less likely to be high users of dual care. Veterans who were Medicare beneficiaries, or had private insurance or chronic illnesses, or were confused about where to seek care were more likely to be users of dual care. Veterans who report being confused about where to seek care, and those who perceive lack of coordination between the VHA and non-VHA systems are less satisfied with care received.

Conclusions

Understanding what motivates veterans to use dual care and influences their satisfaction with care received will enable the VHA to implement policy that improves the quality of care provided to rural veterans.

Ancillary